Most hand pain comes from one of five sources: a joint, a tendon, a nerve, a lump, or an injury. Each one tends to announce itself with a different kind of symptom. Joints ache and stiffen. Tendons catch, click or hurt with one particular movement. Nerves tingle, burn or go numb, often at night. Lumps hurt where something presses on them. Injuries hurt suddenly, from a known moment. Working out which kind of symptom is dominant is usually the fastest route to the right diagnosis.
Counting the wrist, the hand packs 27 bones, dozens of small joints, the tendons that move every finger and the nerves that supply sensation into a very small space, so several different structures can hurt in almost exactly the same spot. That is why the word “pain” on its own tells a clinician relatively little, and why the details covered in this guide are so useful. This article is an overview: it explains the main families of cause, how to recognise each one, and when a hand problem needs assessment, with links to a more detailed guide for each.
Each tissue in the hand fails in its own characteristic way, and that is what makes the type of symptom such a useful clue.
Joints have cartilage surfaces and a lining that produces lubricating fluid. When either is affected, the result is aching, stiffness and sometimes swelling, typically worse after rest or after heavy use.
Tendons are the cords that connect forearm muscles to the fingers and thumb. They glide through tunnels and under bands of tissue called pulleys. When a tendon or its tunnel thickens, the problem is mechanical: the tendon catches, clicks, or hurts with one particular movement, while the hand feels normal at rest.
Nerves carry sensation and the signals that move the small hand muscles. A squeezed nerve does not usually ache like a joint. It produces tingling, burning, numbness or clumsiness, in a pattern that follows the area that nerve supplies.
Lumps such as ganglion cysts and the nodules of Dupuytren’s disease often cause no pain at all, but hurt when they are pressed, for example by a bag handle or a steering wheel.
Injuries have a story: a fall, a twist, a cut or a blow, followed by pain that started at a known moment.
The most common mistake is to describe all of these simply as “hand pain”. The more precisely a person can say what kind of symptom they have, the more quickly the cause can be found.
Aching finger joints, stiffness after rest, and knobbly swelling at the fingertip or middle finger joints are typical of osteoarthritis, which becomes increasingly common from middle age onwards. The base of the thumb is one of the most commonly affected joints, causing a deep ache when opening jars or turning keys. Osteoarthritis stiffness usually wears off fairly quickly once the hand starts moving.⁶
A different pattern, with soft swelling across several knuckles, stiffness lasting an hour or more, and both hands affected, suggests inflammatory arthritis such as rheumatoid arthritis. This needs prompt assessment, because early treatment protects the joints.⁴
More detail: What Is The Difference Between Inflammatory Arthritis And Osteoarthritis In The Hands?
Trigger finger happens when a finger tendon catches under the pulley at the base of the finger. The finger clicks as it bends or straightens, may lock in a bent position and then release suddenly, and there is often a tender lump in the palm at the base of that finger. The ring finger and thumb are most commonly affected, and it is more common in people with diabetes.³
De Quervain’s tenosynovitis affects two groups of tendons on the thumb side of the wrist. Lifting, gripping and moving the thumb become painful, particularly when lifting a baby or carrying with the thumb spread.³
More detail: Why Does My Thumb Hurt?, Why Does The Palm Of My Hand Hurt? and Why Does My Wrist Hurt When I Pick Up My Baby?
Carpal tunnel syndrome is the most common nerve problem in the hand. The median nerve is squeezed as it passes through a tunnel at the front of the wrist, causing tingling and numbness in the thumb, index and middle fingers and half of the ring finger. Symptoms are typically worse at night, often wake people from sleep, and are commonly eased by shaking the hand. The little finger is usually spared, which is an important clue.²
Tingling mainly in the little finger and half of the ring finger points instead to the ulnar nerve, most often squeezed at the elbow, and is commonly worse when the elbow is bent for long periods, for example while holding a phone.³
Nerve symptoms that reach the hand can also start in the neck, which is one reason why an examination checks the whole arm.
More detail: Carpal Tunnel Syndrome: Causes, Diagnosis And Treatment.
A ganglion cyst is a fluid-filled swelling that grows from a joint or tendon sheath, most often on the back of the wrist. A pea-sized version at the base of a finger, known as a pearl ganglion, can be very sore when gripping.⁷ Dupuytren’s disease causes firm nodules in the palm that may slowly form cords, gradually pulling one or more fingers into a bent position.
Most hand lumps are benign, but a lump that is growing quickly, is fixed and hard, or is causing numbness should be examined.
More detail: Why Does A Lump In My Palm Hurt When I Grip?
Falls onto an outstretched hand, sporting injuries, punches and cuts can damage bones, ligaments and tendons. A hand can still move despite a broken bone or a cut tendon, so being able to move the fingers is not proof that nothing is broken. After a fall onto the hand, tenderness at the thumb side of the wrist needs particular care, because a scaphoid fracture can be invisible on the first X-ray.⁸
More detail: Why Does The Back Of My Hand Hurt?, Why Does My Wrist Hurt? and Why Scaphoid Fractures Are Missed.
A finger that becomes red, hot, swollen and very painful over a day or two, especially after a small cut, splinter or bite, can have an infection of the tendon sheath. Warning signs include the finger resting in a slightly bent position, swelling along the whole finger, and severe pain when the finger is gently straightened.⁵ This needs same-day medical assessment, because tendon sheath infections can damage the tendon quickly.
Most people with arm and hand pain have a specific, identifiable cause. In a UK population study, 1,960 working-age adults who reported arm or hand pain were examined using a standard protocol. Of those with pain, 44.8% had one or more specific conditions identified, and people with a specific condition were more likely to report being unable to perform everyday tasks, to have seen a doctor and to be using prescribed medication.¹ Persistent hand pain is therefore usually worth a proper examination rather than being written off as general strain.
Pain and appearance often do not match. In the Rotterdam Study of 7,983 adults aged 55 and over, about one in six had had hand pain in the previous month. Arthritis showing on a hand X-ray turned out to be a very poor predictor of who had pain: many people with clear X-ray changes had no pain at all, and many people with painful hands had little to see on the X-ray.⁶ An X-ray showing wear and tear does not, on its own, explain a painful hand.
Many people say their grip is “weak” when they mean three quite different things, and separating them helps a great deal.
A person who keeps dropping things without pain should not wait for pain to develop before seeking advice.
For mild symptoms without injury or any warning signs, it is reasonable to reduce the particular activity that triggers the pain, while keeping the hand moving comfortably. Complete rest is rarely necessary and can make stiffness worse. A short diary noting which fingers are affected, which activity triggers the symptoms, and whether there is tingling, clicking or swelling makes any later appointment far more productive.
Generic braces and supports are best avoided until the cause is known, because a support designed for one problem can restrict the wrong movement for another. Practical self-care for each condition is covered in How Can I Ease Sore Hands And Fingers?
Book a routine appointment with a hand specialist if pain keeps returning, is affecting work, sleep or everyday tasks, or has not improved after a few weeks of sensible changes, or if a finger catches or locks, or a lump is growing.
Seek an appointment within days for numbness that is constant rather than occasional, for muscle wasting at the base of the thumb, or for soft swelling of several finger joints with long morning stiffness.² ⁴
Seek same-day medical help for a hot, swollen, very painful finger or joint, particularly with a fever or after a cut or bite; a deep cut with numbness or loss of finger movement; severe pain or deformity after an injury; or a hand that becomes pale, cold or blue.⁵ NHS 111 can direct urgent care when the right service is unclear, and 999 should be called in an emergency.
A hand specialist starts by establishing which kind of symptom dominates, where exactly it is, and how and when it started. The examination then tests the structures that fit that story: joints for swelling and movement, tendons for catching and tenderness, nerves for sensation and muscle strength, and any lump for its size, firmness and attachment.
Many hand conditions can be diagnosed from the history and examination alone. Tests are added when they would change the plan: X-rays for injuries and joint problems, ultrasound for tendons and lumps, and nerve conduction studies when the diagnosis or severity of a nerve problem is uncertain or surgery is being considered.² At iiS Health, the ultrasound machine is in the consultation room, so a scan can usually be carried out there and then, as part of the appointment and at no extra cost. This is why consultations are 30 minutes long.
“Hand pain is usually just overuse.”
Repetitive activity can bring symptoms on, but in a UK population study almost half of people with arm and hand pain had a specific condition on examination.¹ Identifying it usually leads to more effective treatment than rest alone.
“Tingling is just another kind of pain.”
Tingling and numbness are signs that a nerve is being affected. They need a different examination from a painful joint, and constant numbness or muscle wasting should not be left untreated.²
“If I can move my fingers, nothing is broken.”
Movement is often possible despite a fracture or a partially cut tendon. Persistent tenderness after a fall or blow, especially at the thumb side of the wrist, should be assessed.⁸
“A normal X-ray means nothing is wrong.”
X-rays show bones and joints. They do not show tendons, nerves or most ligaments, and some scaphoid fractures do not show on the first X-ray.⁸
What is the most common cause of hand pain?
It varies with age. Osteoarthritis of the finger joints and thumb base becomes increasingly common from middle age, while carpal tunnel syndrome, trigger finger and De Quervain’s tenosynovitis are common across adult life.³ ⁶ The pattern of symptoms is a better guide than age alone.
Can hand pain come from the neck?
Yes. A trapped nerve in the neck can cause tingling, numbness or pain in the hand. Neck pain, symptoms spreading down the whole arm, or numbness that does not fit one hand nerve are clues that the source may be higher up.
Why is my hand worse at night?
In carpal tunnel syndrome, the most common cause of hand symptoms that wake people at night, the reason lies in the balance of the forearm muscles. The muscles that bend the wrist and fingers are stronger than those that straighten them. When a person relaxes in sleep, the stronger muscles win: the wrist drifts into a bent position and the fingers curl up. In that position the space inside the carpal tunnel is at its tightest, so pressure on the nerve rises and the tingling and numbness wake the person up.² This is also why a splint that keeps the wrist straight at night often helps. Throbbing pain at night with a hot, swollen joint is different and needs prompt assessment.
Why do I keep dropping things?
Objects can slip because gripping hurts, because the fingers cannot feel properly, or because the hand muscles are genuinely weak. Dropping things without much pain points towards a nerve problem and is worth having examined.
Do I need a GP referral to see a hand specialist?
Not at The Cheshire Hand Clinic. Patients paying for their own care can book directly, without a GP referral. Some insurance companies ask for a GP referral before they will cover treatment, so insured patients should check with their insurer first. Seeing a hand specialist from the start often means the right diagnosis is made sooner.
Can I have more than one hand problem at once?
Yes. Carpal tunnel syndrome and trigger finger, for example, frequently occur together, and arthritis can coexist with nerve or tendon problems.³ Treatment deals first with whichever problem is most time-sensitive, meaning the one that could cause lasting damage if it is left. A nerve that stays compressed can be permanently damaged, so it is usually treated before a less urgent problem. Similarly, a cut tendon needs repairing promptly, because the two ends pull apart over time and a delayed repair is more complicated.
iiS Health, based at The Cheshire Hand Clinic in Warrington, provides specialist assessment and both surgical and non-surgical treatment for hand and wrist conditions.
Mr Fizan Younis is a Consultant Orthopaedic Hand and Wrist Surgeon and the founder and Medical Director of iiS Health. His procedural interests include wrist arthroscopy, endoscopic surgery and ultrasound-guided treatment.
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